Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA 02111
www.mass.gov/dma
MASSHEALTH
TRANSMITTAL LETTER NF-44
September 2002
TO: Nursing Facilities Participating in MassHealth
FROM: Wendy E. Warring, Commissioner
RE: Nursing Facility Manual (Corrected Pages)
This letter transmits corrected pages for the Nursing Facility Manual. Transmittal Letter NF-43,
dated June 2002, inadvertently omitted updated provisions to certain sections of the nursing
facility regulations that had been introduced under Transmittal Letter NF-42, dated
March 2002. Please update your provider manual with the attached pages.
We apologize for any confusion this error may have caused.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Nursing Facilty Manual
Pages iv-a, 4-1, 4-2, and 4-23 through 4-26
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Nursing Facility Manual
Pages iv-a, 4-1, 4-2, and 4-23 through 4-26 — transmitted by Transmittal Letter NF-43
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
TABLE OF CONTENTS
PAGE
iv-a
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
4. PROGRAM REGULATIONS (cont.)
456.605: Petty Cash in the Facility................................................................................... 4-18
456.606: Assurance of Financial Security........................................................................ 4-18
456.607: Availability of PNA Records to Division Personnel.......................................... 4-19
456.608: Member Signature.............................................................................................. 4-19
456.609: Notification of Account Balance........................................................................ 4-19
456.610: Availability of PNA Records to Members......................................................... 4-19
456.611: PNA Funds of a Member Transferred to Another Facility................................ 4-19
456.612: PNA Funds of a Member Discharged to the Community.................................. 4-19
456.613: Member Is Transferred to a Hospital and Does Not Return to the Facility....... 4-20
456.614: Death of a Member............................................................................................ 4-20
456.615: Annual Accounting to the Division of PNA Balance........................................ 4-21
(130 CMR 456.616 through 456.620 Reserved)
456.621: Return of Unused Unit-Dose Drugs................................................................... 4-22
(130 CMR 456.622 through 456.700 Reserved)
456.701: Notice Requirements for Transfers and Discharges Initiated
by a Nursing Facility.......................................................................................... 4-24
456.702: Time Frames for Notices Issued by Nursing Facilities...................................... 4-25
456.703: Time Frames for Submission of Requests for Fair Hearings............................. 4-25
456.704: Stay of a Transfer or Discharge from a Nursing Facility Pending Appeal........ 4-26
456.705: Scheduling by the Board of Hearings................................................................ 4-26
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS
(130 CMR 456.000)
PAGE
4-1
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
456.401: Nursing Facility Services: Introduction
130 CMR 456.000 establishes the requirements for nursing-facility services under
MassHealth. All nursing facilities participating in MassHealth must comply with the regulations
of the Division of Medical Assistance governing MassHealth including, but not limited to, the
regulations set forth in 130 CMR 456.000 and 130 CMR 450.000.
456.402: Definitions
Board of Hearings — the unit within the Division of Medical Assistance that is responsible for
administering the fair-hearing process under 130 CMR 610.000 and claims for adjudication
hearings under 130 CMR 450.241, including hearings about transfers and discharges of residents
by nursing facilities.
Discharge — the removal from a nursing facility to a noninstitutional setting of an individual who
is a resident where the discharging nursing facility ceases to be legally responsible for the care of
that individual; this includes a nursing facility’s failure to readmit following hospitalization or
other medical leave of absence.
Fair Hearing — an administrative, adjudicatory proceeding conducted pursuant to
130 CMR 610.000 to determine the legal rights, duties, benefits, or privileges of applicants and
members, or residents.
Hospital — an inpatient facility that is licensed as a hospital by the Massachusetts Department of
Public Health.
Length of Stay — the duration of a member's inpatient hospital stay at a Medicare hospital level of
care during a medical leave of absence.
Medical Leave of Absence — an inpatient hospital stay at a Medicare level by a member who is a
resident of a nursing facility. The Division will pay the nursing facility for up to 10 consecutive
medical leave-of-absence days in a hospital.
Medicare Hospital Level of Care — a level of care that meets all criteria, as determined by the
Centers for Medicare and Medicaid Services or its agent, for MassHealth payment for hospital
care.
Member — a person determined by the Division to be eligible for MassHealth.
Mobility System . any manual or motorized wheelchair or other wheeled device, such as a
scooter, including its components, accessories, and modifications, that is prescribed by a
physician.
Nursing Facility — an institution or a distinct part of an institution that meets the
provider-eligibility and certification requirements of 130 CMR 456.404 or 456.405. For
requirements related to the transfer and discharge of residents, the term nursing facility also
includes a nursing facility participating in Medicare, whether or not it participates in MassHealth.
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS
(130 CMR 456.000)
PAGE
4-2
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
Patient-Paid Amount — The portion of monthly income that a member in a nursing facility must
contribute to the cost of care.
Personal Needs Allowance (PNA) — the designated portion of monthly income that a member in
a facility is allowed to keep for personal expenses.
Personal Needs Allowance (PNA) Account — an account or accounts administered by a nursing
facility on behalf of a member. The account may be used to deposit the PNA and any other
money, such as a gift, belonging to the member.
Resident — an individual receiving care in a nursing facility regardless of whether the individual
is a MassHealth member.
Transfer — movement of a resident from:
(1) a Medicaid- or Medicare-certified bed to a noncertified bed;
(2) a Medicaid-certified bed to a Medicare-certified bed;
(3) a Medicare-certified bed to a Medicaid-certified bed;
(4) one nursing facility to another nursing facility; or
(5) a nursing facility to a hospital, or any other institutional setting.
A nursing facility’s failure to readmit a resident following hospitalization or other medical leave of
absence, resulting in the resident being moved to another institutional setting is also a transfer.
Movement of a resident within the same facility from one certified bed to another bed with the
same certification is not a transfer.
Unit-Dose Packaging — an individual drug product container usually consisting of foil, molded
plastic, or laminate with indentations for a single solid oral dosage form, with any accompanying
materials or components, including labeling. Each individual container fully identifies the drug
and protects the integrity of the dosage. For purposes of 130 CMR 456.000, an assemblage of
multiple, unlabeled single doses (traditional “bingo cards” or “bubble packs”) is not unit-dose
packaging.
Working Days — Monday through Friday except for legal holidays.
456.403: Eligible Members
(A) (1) MassHealth Members. The Division pays for nursing-facility services only when
provided to eligible MassHealth members, subject to the restrictions and limitations in the
Division’s regulations. The Division’s regulations at 130 CMR 450.105 specifically state
which services are covered and which members are eligible to receive those services.
(2) Recipients of Emergency Aid to the Elderly, Disabled and Children. For information on
covered services for recipients of Emergency Aid to the Elderly, Disabled and Children, see
130 CMR 450.106.
(B) For information on verifying member eligibility and coverage type, see 130 CMR 450.107.
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS
(130 CMR 456.000)
PAGE
4-23
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
(E) Recordkeeping Requirements. The nursing facility must establish tracking and recordkeeping
systems for all unit-dose-packaged drugs returned pursuant to 130 CMR 456.621. The records
must reflect sound standard business accounting practices; be available for review by the Division
upon request; and be kept for at least seven years from the date of the return. The records must
include:
(1) a copy of the manifest described in 130 CMR 456.621(D) of each shipment of unused
unit-dose-packaged drugs that has been returned to the pharmacy;
(2) for unit-dose-packaged drugs that are not returned pursuant to 130 CMR 456.621(B), the
reason that the drugs are not being returned; and
(3) for unit-dose-packaged drugs that were destroyed, the quantity, reason, and date of
destruction, along with the initials of the person who destroyed the drugs.
(130 CMR 456.622 through 456.700 Reserved)
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS
(130 CMR 456.000)
PAGE
4-24
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
456.701: Notice Requirements for Transfers and Discharges Initiated by a Nursing Facility
(A) A resident may be transferred or discharged from a nursing facility only when:
(1) the transfer or discharge is necessary for the resident's welfare and the resident's needs
cannot be met in the nursing facility;
(2) the transfer or discharge is appropriate because the resident's health has improved
sufficiently so that the resident no longer needs the services provided by the nursing facility;
(3) the safety of individuals in the nursing facility is endangered;
(4) the health of individuals in the nursing facility would otherwise be endangered;
(5) the resident has failed, after reasonable and appropriate notice, to pay for (or failed to
have the Division or Medicare pay for) a stay at the nursing facility; or
(6) the nursing facility ceases to operate.
(B) When the facility transfers or discharges a resident under any of the circumstances specified
in 130 CMR 456.701(A)(1) through (5), the resident's clinical record must contain documentation
to explain the transfer or discharge. The documentation must be made by:
(1) the resident's physician when a transfer or discharge is necessary under 130 CMR
456.701(A)(1) or (2); and
(2) a physician when the transfer or discharge is necessary under 130 CMR 456.701(A)(3) or
(4).
(C) Before a nursing facility discharges or transfers any resident, the nursing facility must hand
deliver to the resident and mail to a designated family member or legal representative a notice
written in 12-point or larger type that contains, in a language the member understands, the
following:
(1) the action to be taken by the nursing facility;
(2) the specific reason or reasons for the discharge or transfer;
(3) the effective date of the discharge or transfer;
(4) the location to which the resident is to be discharged or transferred;
(5) a statement informing the resident of his or her right to request a hearing before the
Division’s Board of Hearings including:
(a) the address to send a request for a hearing;
(b) the time frame for requesting a hearing as provided for under 130 CMR 456.702; and
(c) the effect of requesting a hearing as provided for under 130 CMR 456.704;
(6) the name, address, and telephone number of the local long-term-care ombudsman office;
(7) for nursing-facility residents with developmental disabilities, the address and telephone
number of the agency responsible for the protection and advocacy of developmentally
disabled individuals established under Part C of the Developmental Disabilities Assistance
and Bill of Rights Act (42 U.S.C. s. 6041 et seq.);
(8) for nursing-facility residents who are mentally ill, the mailing address and telephone
number of the agency responsible for the protection and advocacy of mentally ill individuals
established under the Protection and Advocacy for Mentally Ill Individuals Act
(42 U.S.C. s. 10801 et seq.);
(9) a statement that all residents may seek legal assistance and that free legal assistance may
be available through their local legal-services office. The notice should contain the address of
the nearest legal-services office; and
(10) the name of a person at the nursing facility who can answer any questions the resident
has about the notice and who will be available to assist the resident in filing an appeal.
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS
(130 CMR 456.000)
PAGE
4-25
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
(D) A nursing facility’s failure to readmit a resident following a medical leave of absence shall be
deemed a transfer or discharge (depending on the resident’s circumstances). The nursing facility
must issue notice to the resident and an immediate family member or legal representative in
accordance with 130 CMR 456.701(A) through (C), 456.702(C), 610.028, and 610.029.
456.702: Time Frames for Notices Issued by Nursing Facilities
(A) The notice of discharge or transfer required under 130 CMR 456.701(C) must be made by the
nursing facility at least 30 days prior to the date the resident is to be discharged or transferred,
except as provided for under 130 CMR 456.702(B).
(B) Instead of the 30-day-notice requirement set forth in 130 CMR 456.702(A), the notice of
discharge or transfer required under 130 CMR 456.701 must be made as soon as practicable before
the discharge or transfer in any of the following circumstances, which are emergency discharges
or emergency transfers.
(1) The health or safety of individuals in the nursing facility would be endangered and this is
documented in the resident's record by a physician.
(2) The resident's health improves sufficiently to allow a more immediate transfer or
discharge and the resident's attending physician documents this in the resident's record.
(3) An immediate transfer or discharge is required by the resident's urgent medical needs and
this is documented in the medical record by the resident's attending physician.
(4) The resident has not resided in the nursing facility for 30 days immediately prior to
receipt of the notice.
(C) When the transfer or discharge is the result of a nursing facility’s failure to readmit a resident
following hospitalization or other medical leave of absence, the notice of transfer or discharge,
including that which is required under 130 CMR 456.429, must comply with the requirements set
forth in 130 CMR 456.701 and must be provided to the resident and an immediate family member
or legal representative at the time the nursing facility determines that it will not readmit the
resident.
456.703: Time Frames for Submission of Requests for Fair Hearings
(A) Appeals of discharges and transfers will be handled by the Division’s Board of Hearings
(BOH).
(B) Time Limitation on the Right of Appeal. The date of request for a fair hearing is the date on
which BOH receives such a request in writing. BOH must receive the request for a fair hearing
within the following time limits:
(1) 30 days after a resident receives written notice of a discharge or transfer pursuant to 130
CMR 456.702(A); or
(2) 14 days after a resident receives written notice of an emergency discharge or emergency
transfer pursuant to 130 CMR 456.702(B); or
(3) 14 days after a resident receives written notice of a transfer or discharge that is the result
of a nursing facility’s failure to readmit a resident following hospitalization or other medical
leave of absence.
Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS
(130 CMR 456.000)
PAGE
4-26
NURSING FACILITY MANUAL
TRANSMITTL LETTER
A
NF-44
DATE
09/01/02
456.704: Stay of a Transfer or Discharge from a Nursing Facility Pending Appeal
(A) If a request for a hearing regarding a discharge or transfer from a nursing facility is received
by the Board of Hearings during the notice period described in 130 CMR 456.703(B)(1), the
nursing facility must stay the planned discharge or transfer until 30 days after the decision is
rendered. While this stay is in effect, the resident must not be transferred or discharged from the
nursing facility.
(B) If a hearing is requested, in accordance with 130 CMR 456.703(B)(2), and the request is
received prior to the discharge or transfer, then the nursing facility must stay the planned transfer
or discharge until five days after the hearing decision.
(C) If the request for a hearing is received within the applicable time frame but after the transfer,
the nursing facility must, upon receipt of the appeal decision favorable to the resident, promptly
readmit the resident to the next available bed in the facility.
(D) In the case of a transfer or discharge that is the result of a nursing facility’s failure to readmit
a resident following hospitalization or other medical leave of absence, if the request for a hearing
is received within the applicable time period as described in 130 CMR 456.703(B)(3), the nursing
facility must, upon receipt of the appeal decision favorable to the resident, promptly readmit the
resident to the next available bed.
456.705: Scheduling by the Board of Hearings
(A) Upon receipt of a request for a fair hearing, BOH will register the appeal, set a date for a
hearing, and so notify the appellant and the nursing facility.
(B) BOH will designate a site for the hearing accessible to the appellant. If the appellant has a
handicap or disability that reasonably prevents his or her appearance at the designated site, he or
she may request that the hearing be held by telephone or video conferencing, or at an accessible
location.
REGULATORY AUTHORITY
130 CMR 456.000: M.G.L. c. 118E, §§ 7 and 12.